儿童梨状窝瘘41例

目的提高对儿童梨状窝瘘的认识，介绍相关诊断与治疗进展。方法报告41例梨状窝瘘病例，男16例，女25例，年龄9个月至12岁3个月；左侧40例，右侧1例；33例行颈部超声显像，20例行CT柃查，29例行甲状腺核素显像，39例行食管吞钡造影。28例手术治疗，其中20例应用胃镜辅助，并对37例进行随访，随访时间18个月至17年6个月。结果超声检查显示：32例病变侧甲状腺实质不均质占位或软组织实质不均质占位，与甲状腺关系密切；CT检查提示：病变侧颈部炎性肿块或合并甲状腺内炎性占位性病变，其中5例直接诊断为梨状窝瘘；核素显像提示：26例甲状腺左叶、特别是上极放射性稀疏，2例呈“冷结节”；食管吞钡检查显示：左侧或右侧梨状窝底部有垂直下行的细小瘘管。10例单纯切除术中8例治愈，2例复发，经胃镜辅助治愈；20例经胃镜辅助切除病例中，2例复发；13例未手术，其中9例获随访，5例自愈或未发作，4例仍反复发作。结论儿童梨状窝瘘炎症消退后食道吞钡检查可明确诊断，CT、B超及同位素检查在梨状窝瘘的诊断中也起着非常重要的作用，手术切除瘘管是主要的治疗方法，关键在于完整切除或消灭瘘管；胃镜辅助检查有助于瘘管的寻找，从而保证瘘管的完整切除，是一种简便、有效的治疗手段。     

新生儿梨状窝瘘的诊治特点

目的 阐述新生儿梨状窝瘘这一少见疾病的诊治特点.方法 收集我院2001年7月至2010年1月收治的9例新生儿梨状窝瘘病例,分析其发病年龄、临床表现、辅助检查及临床治疗经过,总结其诊治特点和预后.结果 9例梨状窝瘘均为左侧.均以颈部囊性肿块就诊.8例为新生儿时期出现症状,1例为产前发现.5例颈部增强CT提示肿块中含有气体.新生儿时期手术治疗7例.随访时间6个月至9年,患儿临床均无反复感染或复发迹象.结论 新生儿的梨状窝瘘临床表现不同于儿童,常因颈部无痛性、囊性肿块就诊,缺少反复脓肿切开引流史.超声或CT检查中常可发现囊肿中含有气体影.新生儿早期手术瘘管结扎率高,部分需要胃镜辅助.治疗安全性可靠,术后复发率低且预后良好.     

新生儿梨状窝瘘的诊治特点

目的 阐述新生儿梨状窝瘘这一少见疾病的诊治特点.方法 收集我院2001年7月至2010年1月收治的9例新生儿梨状窝瘘病例,分析其发病年龄、临床表现、辅助检查及临床治疗经过,总结其诊治特点和预后.结果 9例梨状窝瘘均为左侧.均以颈部囊性肿块就诊.8例为新生儿时期出现症状,1例为产前发现.5例颈部增强CT提示肿块中含有气体.新生儿时期手术治疗7例.随访时间6个月至9年,患儿临床均无反复感染或复发迹象.结论 新生儿的梨状窝瘘临床表现不同于儿童,常因颈部无痛性、囊性肿块就诊,缺少反复脓肿切开引流史.超声或CT检查中常可发现囊肿中含有气体影.新生儿早期手术瘘管结扎率高,部分需要胃镜辅助.治疗安全性可靠,术后复发率低且预后良好.     

儿童颈部梨状窝瘘诊治进展

梨状窝瘘多以小儿反复发作的单侧（左侧为主）颈部炎性脓肿或急性化脓性甲状腺炎等症状就诊,以往在治疗上多为反复颈部脓肿切开引流及联合多种抗生素对症缓解症状或是开放性常规分离瘘管手术寻求根治,但复发率较高。该文通过总结近年梨状窝瘘相关诊断和治疗进展,旨在强调对于疑似患儿需及时行超声、CT、上消化道钡餐等检查,必要时做内镜检查,治疗上在非急性期以内镜辅助下导管置入或亚甲蓝内口注射行梨状窝瘘切除术可明显减少复发率。     

内镜辅助梨状窝瘘切除术

梨状窝瘘是一种少见的颈部鳃源性疾病,主要表现为反复发作的颈部感染或类似化脓性甲状腺炎表现,临床及易误诊。治疗的关键是彻底切除瘘管,但由于局部反复感染,瘘管及其周围组织致密粘连,术中瘘管难以寻找,或切除不完全,术后易复发。采用内镜辅助寻找瘘管能有效提高手术成功率。     

个体化术式选择治疗儿童梨状窝瘘的效果分析

目的:探讨个体化术式选择治疗儿童梨状窝瘘的效果。方法:选取2015年6月至2019年11月河南省人民医院小儿外科收治的43例梨状窝瘘患儿,左侧41例,右侧2例;炎症控制期27例,急性炎症期16例;根据个体病情选择低温等离子射频消融、梨状窝瘘切除、颈部脓肿切开引流等术式或联合术式,观察术后并发症及复发情况。结果:43例梨...     

经直肠入路治疗后天性直肠前庭瘘术式的疗效

目的 总结改进的经直肠入路手术治疗后天性直肠前庭瘘的疗效,评估其手术方法。方法 回顾性分析101例经直肠入路切除后天性直肠前庭瘘瘘管患儿的临床资料。年龄4个月~14岁,平均4岁4个月。患儿排气及排稀便时,自前庭部瘘口有气体及少量稀便漏出。瘘管外口多位于舟状窝处,内口均位于直肠前壁正中齿状线水平。均采用改进的经直肠入路瘘管切除术治疗。结果 术后痊愈95倒,手术成功率94％。瘘管复发6例,经对症处理后3例自行愈合。另3例0.5年后2次手术治愈。结论 经直肠瘘管切除术是治疗后天性直肠前庭瘘的安全、可靠的手术方法之一。     

婴幼儿先天性肛门闭锁舟状窝瘘的治疗

目的探讨婴幼儿先天性肛门闭锁舟状窝瘘的手术治疗方法。方法回顾性分析我院2002年1月～2006年12月收治的32例先天性肛门闭锁舟状窝瘘的临床资料。结果32例平均年龄11个月(4个月～1岁8个月),均通过保留瘘管肛门成形术治愈,其中2例术后出现肛周伤口感染,经5～7d局部理疗、外涂碘伏后痊愈。32例随访6个月～5年,肛门会阴外观正常,无肛门狭窄及复发肛瘘,肛门排便功能评定结果均为优。结论保留瘘管肛门成形术治疗婴幼儿先天性肛门闭锁舟状窝瘘具有操作简便,损伤小,并发症少等优点。     

儿童甲状舌管囊肿及瘘术后复发的原因和预防

目的 探讨甲状舌管囊肿及瘘术后复发的原因和预防措施，减少手术复发率。方法 向43例甲状舌管囊肿及瘘管(含11例复发者)中注入美蓝，以判定囊肿及瘘的范围、分支及走行，彻底切除囊肿及瘘管，切除舌骨中段和其附着的组织及舌骨以上至舌盲孔之间的一段柱状组织。结果 甲状腺囊肿23例，甲状腺舌管瘘6例，囊肿并瘘管2例，囊肿／6并慢性炎症改变12例。43例行囊肿及瘦根治性切除术，40例随访1年以上，均无复发。结论 预防甲状舌管囊肿及瘦术后复发的关键在于明确囊肿及瘦的范围，轻柔操作，仔细解剖，认真辨认，避免撕断而遗留囊肿及瘘管组织。     

先天性肛门闭锁直肠舟状窝会阴瘘26例治疗体会

先天性肛门闭锁伴直肠舟状窝会阴瘘是小儿外科中常见的畸形之一,术后并发症如肛门狭窄、肛门失禁、瘘管复发颇为多见。我们自1994年～2002年共收治先天性肛门闭锁伴直肠舟状窝、会阴瘘患儿26例,均采用直肠末端旋转、倒“V-Y”肛门成形术,疗效满意。现报告如下。1临床资料1.1一般情况本组26例,舟状窝瘘16例,会阴瘘9例,阴唇瘘1例,均为中、低位瘘。年龄3d～4岁,其中2例伴有先天性心脏病(心脏彩超检查为室间隔缺损),1例为右位心。1.2手术方法全麻后取截石位,常规消毒后置“F-8”号导尿管。肛门隐窝两侧用7号丝线对称缝合两针,备作牵引线,正常…     

Recurrent suppurative thyroiditis due to pyriform sinus fistula: a case report

Acute suppurative thyroiditis is a rare disease, particularly in childhood. We present a case with recurrent acute suppurative thyroiditis due to a pyriform sinus fistula originating from the fourth branchial pouch. The typical symptoms of a piriform sinus fistula are recurrent left-sided pain and swelling of the neck with signs of acute bacterial inflammation. Diagnosis should be made by high resolution ultrasound, barium meal studies and endoscopic examination. During acute exacerbations treatment with antibiotics is indicated, but permanent cure can only be attained by complete fistulectomy.     

Perianal abscess and fistula‐in‐ano in children: Aetiology,management and outcome

Aim: We aimed to assess our experience in treatment and outcome of perianal abscess and/or fistula‐in‐ano in children. Method: The patients who were treated for perianal abscess and/or fistula‐in‐ano from January 2000 to December 2005 were included. Age, sex, duration of symptoms, number and site of the perianal abscess and/or fistula‐in‐ano, treatment modality and recurrences were recorded. Results: The study consisted of 39 patients (36 boys) with a mean age of 29 ± 49.1 months. At first examination the diagnosis was perianal abscess in 20 patients, perianal abscess with fistula in five patients and fistula‐in‐ano in 14 patients. No patients had an underlying illness. The primary local treatment of perianal abscess with or without fistula was incision and drainage (with or without antibiotic therapy) in 21 patients, and local care with antibiotic therapy was given to four patients. Of 20 patients with perianal abscess, 17 developed fistula‐in‐ano and three healed. One patient in the perianal abscess group who developed fistula‐in‐ano and two patients in the fistula group were lost to follow‐up. Thirty‐three patients with fistula‐in‐ano underwent surgical treatment either through a fistulotomy or through a fistulectomy. Five (15.1%) patients who experienced recurrent fistula‐in‐ano underwent fistulotomy were completely cured after the second operation. Conclusion: Treatment of a perianal abscess either through incision and drainage with antibiotics or through antibiotics alone resulted in a high rate (85%) of fistula formation. Fistula‐in‐ano can be treated either by fistulotomy or by fistulectomy, both of which are associated with a reasonable chance of recurrence of fistula‐in‐ano formation. We obtained good results in our patients through surgical approach (fistulotomy or fistulectomy), for fistula‐in‐ano formed following treatment of perianal abscess.     

"Massive hemoptysis" and shock after fever and cough北大核心CSCD

11岁男性患儿,因间断发热15 d,咳嗽10 d,“咯血”7 d入院。患儿15 d前以发热咳嗽起病,伴左侧颈部疼痛,抗生素治疗有效。病程中突然出现大“咯血”致休克,后经纤维支气管镜检查发现左侧梨状窝内瘘口并持续渗血,结合颈部及血管影像学检查考虑为先天性梨状窝瘘感染并颈部脓肿致颈内静脉受损血栓形成,通过低温等离子消融梨状窝瘘封闭术治疗后好转,随访1年半未反复。检索文献未发现梨状窝瘘感染引起大出血休克报道,该文总结此例患儿的临床特点及诊治经过,为早期诊断该类疾病及其并发症防治提供参考依据。     

Successful endoscopic ablation of a pyriform sinus fistula in a child: case report and literature review

Recurrent thyroid infections are rare in children. When present, patients should be evaluated for anatomic anomalies such as pyriform sinus fistulae. We describe a 12-year-old girl with history of recurrent thyroid abscesses secondary to a pyriform sinus fistula and managed with concurrent endoscopic ablation and incision and drainage.     

Acute suppurative thyroiditis in children

BACKGROUND: Acute suppurative thyroiditis in children is rare and is often related to a pyriform sinus fistula or thyroglossal duct remnant, especially when it is recurrent. METHODS: From January, 1985, through December, 2000, 15 children with acute suppurative thyroiditis were treated. Their clinical, laboratory and radiologic findings were reviewed and analyzed. RESULTS: There were 8 girls and 7 boys, with a mean age at diagnosis of 6.1+/-2.9 years (range, 1.5 to 9.8). A thyroid mass was present on the left in 13 and on the right in 2 (P < 0.05). Fever, neck pain and swelling were the most common symptoms and signs. Seven patients (46.7%) had recurrent disease. Needle aspiration for Gram stain and bacterial cultures were done, and pathogenic organisms were identified on culture in 8 patients but were found only on Gram stain in 2 patients. In one-half of the patients with positive cultures, mixed pathogens were found. The most common organisms isolated were streptococcal species (50%). Barium esophagography was performed in all patients, and 5 (33.3%) had a pyriform sinus fistula on the left. Only 1 of the recurrent patients had a fistula. Thyroid scans were performed in 13 patients, of whom 12 (92.3%) had decreased radioactive uptake. Thyroid function tests were normal in all 15. CONCLUSIONS: Acute suppurative thyroiditis is usually caused by oropharyngeal flora, resulting in mixed pathogens on culture. Broad spectrum antibiotics should be given once cultures have been obtained. Imaging studies might be helpful in the diagnosis of acute suppurative thyroiditis.     

Acute suppurative thyroiditis in young children

We report two children with acute suppurative thyroiditis (AST). They presented with typical features of AST, which include fever, painful goiter and biochemical euthyroidism. An anatomical defect predisposed to thyroid infection, pyriform sinus fistula, was identified in one patient. Both patients responded well to surgical pus drainage and antibiotic treatment. Anatomical defects must be sought in all children with AST to perform specific surgical treatment and prevent recurrent infection.     

Light guided procedure for congenital pyriform sinus fistula; new and simple procedure for impalpable fistula

Pyriform sinus fistula causes acute suppurative thyroiditis, and there is a risk of recurrence if the sinus tract is not excised completely. The tract should be dissected as high as possible toward the pyriform fossa. We report our devised technique “the light guided procedure” for the impalpable fistula. A bronchoscope was inserted into the pyriform sinus fistula with the help of a gastrofiberscope positioned at the larynx. The tract of the fistula was identified with the help of the light from the bronchoscope. We were able to reach the proximal end of the fistula, directly. This procedure is easy, safe, and minimally invasive.